Background and study aims ?The European Society of Gastrointestinal Endoscopy (ESGE) recently issued a quality performance measures document for small bowel capsule endoscopy (SBCE). The aim of this nationwide survey was to explore SBCE practice with ESGE quality measures as a benchmark. Patients and methods ?A dedicated per-center semi-quantitative questionnaire based on ESGE performance measures for SBCE was created by a group of SBCE experts. One-hundred-eighty-one centers were invited to participate and were asked to calculate performance measures for SBCE performed in 2018. Data were compared with 10 ESGE quality standards for both key and minor performance measures. Results ?Ninety-one centers (50.3?%) participated in the data collection. Overall in the last 5 years (2014-2018), 26,615 SBCEs were performed, 5917 of which were done in 2018. Eighty percent or more of the participating centers reached the minimum standard established by the ESGE Small Bowel Working Group (ESBWG) for four performance measures (indications for SBCE, complete small bowel evaluation, diagnostic yield and retention rate). Conversely, compliance with six minimum standards established by ESBWG concerning adequate bowel preparation, patient selection, timing of SBCE in overt bleeding, appropriate reporting, reading protocols and referral to device-assisted enteroscopy was met by only 15.5?%, 10.9?%, 31.1?%, 67.7?%, 53.4?%, and 32.2?% of centers, respectively. Conclusions? The present survey shows significant variability across SBCE centers; only four (4/10 40?%) SBCE procedural minimum standards were met by a relevant proportion of the centers (???80?%). Our data should help in identifying target areas for quality improvement programs in SBCE.Background and study aims ?The use of fluoroscopy during pregnancy should be minimized given that a clear-cut safe radiation dose in pregnancy is unknown. The role of digital single-operator cholangioscopy (D-SOC) as an alternative to standard enodoscopic retrograde cholangiopancreatography (ERCP) in pregnant patients has not been comprehensively studied. This study assessed 1 Technical success defined as performance of ERCP with D-SOC without the use of fluoroscopy in pregnant patients; 2 safety of D-SOC in pregnancy; and 3 maternal and neonatal outcomes after D-SOC during/after pregnancy. Patients and methods This was an international, multicenter, retrospective study at 6 tertiary centers. Pregnant patients who underwent D-SOC for the treatment of bile duct stones and/or strictures were included. Results ?A total of 10 patients underwent D-SOC. Indications for ERCP were choledocholithiasis, strictures, previous stent removal, and choledocholithiasis/stent removal. Bile duct cannulation without fluoroscopy was achieved in 10 of 10 patients (100?%). Moreover, 50?% of patients (5/10) completed a fluoroless ERCP with D-SOC. Mean fluoroscopy dose and fluoroscopy time were 3.4?±?7.2 mGy and 0.5?±?0.8?min, respectively. One case of mild bleeding and one case of moderate post-ERCP pancreatitis occurred. The mean gestational age at delivery was 36.2?±?2.6 weeks. Median birth weight was 2.5?kg [IQR 2.2-2.8]. No birth defects were noted. Conclusion ?ERCP guided by D-SOC appears to be a feasible and effective alternative to standard ERCP in pregnant patients. It enables avoidance of radiation in half of cases.Background and study aims? The therapeutic role of endoscopic ultrasound (EUS) evolved in recent decade,s opening a new chapter in the field of endoscopic biliary drainage (BD). EUS-BD has emerged as a new mini-invasive technique for neoplastic jaundice not amenable to endoscopic retrograde cholangiopancreatography (ERCP). The primary study aims were to assess the clinical efficacy of EUS-BD using an electrocautery-enhanced lumen apposing metal stent (ECE-LAMS) in patients with malignant biliary obstruction with failed\unfeasible ERCP and the adverse event (AE) rate. The secondary aims were to evaluate the technical success and incidence of jaundice recurrence. Patients and methods? Data from All patients referred to our tertiary-care Institute with obstructive jaundice due to unresectable malignant distal biliary stricture and unfeasible\failed ERCP, were prospectively recorded from January 2015 to February 2018. The procedures were performed by a single-step ECE-LAMS (AXIOS-EC, Boston Scientific) placement, from the upper gut lumen to the biliary tree, for definitive biliary decompression. Results? Twenty-one patients were consecutively enrolled. Mean pre-procedure common bile duct diameter was 16?mm and the bilirubin level was 13.9?mg/dL (range 3.8-29.5). https://www.selleckchem.com/products/t0901317.html LAMS was positioned from the duodenal bulb (n?=?19) to gastric antrum (n?=?2). We registered a 100?% of technical and clinical success. No AEs occurred. We observed a single case of delayed AE consisting of a buried LAMS, which was successfully resolved endoscopically. Conclusions? Despite the limits of being non-comparative, our study shows outcomes in a homogeneous population in terms of indications and technique. EUS-BD with dedicated ECE-LAMS is associated with extremely good clinical efficacy and safety and can be considered as an alternative in cases of failed/unfeasible ERCP.The clinical characteristics of atrial fibrillation (AF) resulting from non-pulmonary vein (PV) triggers remain unknown. This study aimed to evaluate the clinical characteristics of patients with AF caused by non-PV triggers, localization of non-PV foci, clinical differences, and clinical outcomes after catheter ablation in each AF focus.
A total of 2967 patients who underwent initial catheter ablation for paroxysmal or persistent AF were examined. After PV isolation, all patients underwent high-dose isoproterenol infusion to assess the existence of non-PV foci.
Non-PV foci were identified in 564 patients (19.2%). The localization of successfully ablated non-PV foci in 514 patients were the superior vena cava (SVC 213 cases), interatrial septum (IAS 125 cases), coronary sinus (CS 98 cases), right atrium (RA 125 cases), left atrium (LA 114 cases), and unmappable (50 cases). Multivariate analysis revealed that female gender, low body mass index (BMI), non-paroxysmal AF (PAF), and sick sinus syndrome were independent and significant indicators of non-PV foci.